Lean PCOS 101: What Is It, How Is It Different, + More!

A note about sex and gender 

Sex and gender exist on spectrums. This article will use the terms “individuals” to refer to female sex assigned at birth. Click here to learn more. 
  • Nearly 80% of PCOS diagnoses include those who are obese or overweight.  
  • 20% of the individuals have lean PCOS 

Lean PCOS is a common condition that occurs in individuals with ovaries. Polycystic ovary syndrome is when multiple cysts appear in the ovary. This can cause a lot of complications for the person and lead to issues in their reproductive health. It may be infertility, irregular periods, and hair growth. 

So, what’s lean PCOS? Is it like lean protein? People with PCOS wish it was that. Lean PCOS is the type of syndrome that does not include obesity or overweight. This includes individuals who are within the ‘normal’ weight. Normal here implies the recommended weight is an individual’s height and weight. 

Moreover, contrary to popular belief, only people who are obese or overweight do not have PCOS. Even those within the healthy weight range can experience it. 

Continue reading the article to know more about the challenges, and management options for individuals with lean PCOS.  

What is Lean PCOS?

What is Lean PCOS?

Lean PCOS affects individuals who have a BMI of 25 or less. BMI, or the Body Mass Index, determines the body fat percentage. This measure considers an individual’s height and weight to compute the fat percentage. This determines whether a person is obese or overweight, or in the ‘normal’ weight range. 

How do you know if you are in the ‘normal’ range? Just find a reliable tool such as the one from the NHLBI. However, here’s a quick look: 

– If your BMI is 18.5 or less, you are underweight 

– If your BMI is within 18.5-24.9, you are within the normal range. 

– You are overweight if your BMI computes to be within 25-29.9 

– And, if your BMI is 30 or greater, then you are obese. 

Lean PCOS requires different treatment than other PCOS types. This condition results in an excess amount of androgen produced in the body, which can lead to changes in the physical features. This can be excess hair growth. 

Characteristics of Lean PCOS

Characteristics of Lean PCOS

The following are the characteristics of lean PCOS. Take a look to know what is correct for you: 

– People with lean PCOS have high androgen levels 

– They also experience irregular periods or a lack of ovulation 

– Small cysts may form on one or both ovaries 

– Low-grade inflammation 

– Oxidative stress 

– Insulin resistance 

– There can also be excessive hair growth in different body areas, such as the face. This is known as hirsutism. 

– Thinning of hair 

– You may also experience skin tags 

– There may also be areas with dark skin. For example, under the breasts, groin, or neck crease. 

The incidence of insulin resistance is prominent in the case of lean PCOS, when the cells in the body do not respond well to the hormone insulin. The tissues do not use insulin appropriately, which can occur in either of the two types of PCOS. 

Albeit low, there are proper incidences of intrinsic form of insulin resistance. 

In addition, the condition can also cause hormonal abnormalities, which are the hallmark of PCOS. This syndrome leads to an increase in the hormone androgen, which is the male sex hormone. 

The most prominent sign of this change is the presence of excess hair on the face. It can also be present on the chest and back. This can be difficult for those individuals who identify as female, as it can cause emotional and psychological trauma due to societal pressure. 

There may also be similarities in the metabolic profiles of individuals with lean PCOS. This may be observed as similar levels of visceral fat, which is a hormonal feature of body fat that affects processes within the body. 

Management of Lean PCOS 

Management of Lean PCOS 

A person with lean PCOS may face several challenges, which may be psychological, emotional, and mental in nature apart from being physical. 

These challenges may even be as follows: 

– Fertility issues 

– High risk of diabetes or heart disease that is undiagnosed. 

– High level of androgen that can cause acne, hair loss 

Apart from these, there are also the following: 

  • Different treatment mode for lean PCOS 
  • Dietary consideration is a formidable part of lifestyle modification. 

There are several management options for lean PCOS, but the most common ones are: 

  • Lifestyle modifications 
  • Pharmacological measures such as those for improving insulin resistance 
  • Ameliorating androgen levels in the blood with medication 
  • Downregulation of androgen synthesis by the ovaries with the use of medication 

A certain type of management system exists for lean PCOS. An inadequate response from one management option can lead to reconsideration of the plan targeting the challenges a person with lean PCOS faces. 

The lifestyle changes mainly focus on avoiding weight gain and maintaining the patient’s weight at a healthy mark that does not cause complications. This is through dietary modification, a balanced diet, or something appropriate for the patient. These may be: 

  • Increasing the consumption of fruits and vegetables (depending on the individual’s needs and digestive abilities) 
  • Vitamin D and calcium supplements if they cannot get adequate amounts from natural sources 
  • Regular exercising to keep fit 

Management Options For Additional Conditions

Management Options For Additional Conditions

When lifestyle changes fail to make a difference in the condition, and there are other conditions present, it is best to: 

Add medications such as myoinositol or metformin upon the doctor’s advice. 

If the issue of hirsutism (excess “male-like” hair growth) exists, then shaving, laser treatment, and electrolysis are possible additional management options. 

Moreover, if the patient has menstrual dysfunction, progesterone is a good treatment option or a combination of treatment with an oral contraceptive pill. 

If the patient experiences acne issues, topical ointment is an additional treatment. This can be oral antibiotics, retinoids, and benzyl peroxide. Isotretinoin in severe cases of acne can prove to be helpful as well. 

Another common issue that people with lean PCOS face is infertility. This can easily be solved with the help of pharmacotherapy, such as using gonadotrophins or clomifene citrate. 

Surgical options are also available for infertility, for instance, unilateral or bilateral laparoscopic ovarian drilling. 

In vitro fertilization is a common solution to infertility in cases without lean PCOS as well. 

Importance of further research in managing lean PCOS 

All the above information comes from individual research through databases containing the latest developments in treating and managing lean PCOS. It reinstates the importance of research in managing lean PCOS. 


A common question that most of my readers will have – to give you a short answer, there isn’t a lot of data to represent everyone who experiences the various complications. Just the experience of lean PCOS differs among individuals. Ethnicities, socioeconomic status, gender, genetics, and family history introduce the disparity. 

Another common issue in individuals with lean PCOS is anovulation, the absence or decrease in ovulation. This causes infertility in them. So far, the scientific data represented obese individuals who were struggling with infertility due to coexisting factors. Thus, here’s another research gap that requires filling soon. 


This was all on lean PCOS and its impact on individuals. The information may seem overwhelming if you are reading about this condition for the first time. However, there is ample evidence that suggests high chances of stability for patients. 

The uncertainties, also known as complications, require additional treatment to support the primary plan. So far, the existing management options for these challenges include pharmacotherapy or surgical interventions. Both may have side effects impacting the individual’s quality of life. 

Know any other management options? Let us know in the comments below!

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